Korean Circ J.  2011 Jun;41(6):327-330. 10.4070/kcj.2011.41.6.327.

Recanalization of an Accidentally Crushed Coronary Stent by Intravascular Ultrasonography Catheter Entrapment

• Kim JY
• Lee NH
• Cho YH
• Suh J
• Seo HS
• Kim DH
• Jeon YW

• KMID: 1776190
• DOI: http://doi.org/10.4070/kcj.2011.41.6.327

Abstract

Intravascular ultrasonography (IVUS) imaging is a user-friendly technique widely used during coronary interventions. An 80-year-old man was admitted with chest pain, and successful percutaneous coronary intervention was performed with stent implantation. One week later, the patient complained of further chest pain. Urgent coronary angiography showed total occlusion of the middle left anterior descending artery and the aspiration of thrombi was high. IVUS imaging showed inadequate stent strut apposition and distal dissection. We attempted another stent implantation but the IVUS catheter was stuck on the 0.014 inch wire. Therefore, we tried to pass the wire across the lateral side. After the wire was successfully passaged, the sprinter balloon was passed through the crushed stent to expand it. After 4 days later, the patient was discharged with no symptoms or electrocardiographic change.

Keyword

Intravascular ultrasonography; Percutaneous transluminal coronary angioplasty; Stents

MeSH Terms

Aged, 80 and over
Angioplasty, Balloon, Coronary
Arteries
Catheters
Chest Pain
Coronary Angiography
Electrocardiography
Humans
Percutaneous Coronary Intervention
Stents
Ultrasonography, Interventional

Figure

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  Fig. 1 Baseline coronary angiography: significant narrowing and severe calcification of distal left main coronary artery and middle left anterior descending artery.

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  Fig. 2 Post PCI: middle left anterior descending artery was successfully addressed by PCI performed with stent implantation. PCI: percutaneous coronary intervention.

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  Fig. 3 Subacute stent thrombosis: coronary angiography showed total occlusion of middle left anterior descending artery.

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  Fig. 4 Post thrombi aspiration using a thrombuster catheter.

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  Fig. 5 After IVUS removal: coronary angiography (A) showed a totally occluded left anterior descending artery (indicated by arrow) by crushed stent (thrombolysis in myocardial infarction 0 flow), and the middle left anterior descending artery was dissected on IVUS image (B). IVUS: intravascular ultrasonography.

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  Fig. 6 Wire passage through the lateral portion of the crushed stent.

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  Fig. 7 Final coronary angiography: percutaneous coronary intervention using sequential large balloon. A Coroflex Blue stent was successfully implanted with higher pressure.

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